The proposed collaboration among the Center For Health Care Strategies (CHCS), The Robert F. Wagner Graduate School for Public Service of New York University (NYU) and the Primary Care Information Project (PCIP) of the New York City Department of Health and Mental Hygiene (NYCDOHMH) will capitalize on the ongoing efforts of PCIP to transform primary care practices in New York City and the extensive amount of available data describing these practices. The proposed study will focus on a diverse set of small urban practices (<5 providers) with high volumes of Medicaid and/or uninsured patients that have been engaged in multiple transformation processes under the auspices of the PCIP for at least one year. The main goals of the study are to: 1) Utilize secondary data for a large number (N=105+) of small, urban primary care practices that have undergone transformation processes for at least one year to understand changes in management/transformation processes, status and changes in health care processes, and status and changes in patient outcomes and the interrelationships among these variables;2) Utilize mixed methods, including a provider survey and key informant interviews with patients, to assess the effects of practice transformation activities on health care providers and their patients;3) Use a detailed practice assessment, site visits, and key informant interviews to examine in depth the implementation of transformation components with attention to the organizational and contextual factors that affected implementation and success in 40 selected practices;and 4) Disseminate the findings from this study widely via presentations at conferences and meetings of professional organizations and medical societies, a web based "tool kit" of best practices, and peer-reviewed journal articles. PUBLIC HEALTH RELEVANCE: The proposed study will inform primary care providers, payers, health services researchers, and policy-makers about methods to achieve primary care practice transformation in small practices with high volumes of Medicaid and uninsured patients. In a time of increasing resource constraints, rising medical need, and a projected shortage of primary care providers, such information will be critical to ensuring patient-centered primary medical care for all patients in the US, particularly the most vulnerable.